Perceptions of Infection Control Among Nurses

Shoukat S et al.,
DOI: https://doi.org/10.54393/pjhs.v4i01.487

PAKISTAN JOURNAL OF HEALTH SCIENCES

https://thejas.com.pk/index.php/pjhs
Volume 4, Issue 1 (January 2023)

Orıgınal Artıcle
Perceptions of Infection Control Among Nurses Regarding Barriers: A Qualitative
Study

Saffora Shoukat1*, Afsar Ali1 and Zunaira Aziz1

¹Lahore School of Nursing, Faculty of Allied Health & Sciences, The University of Lahore, Pakistan

ARTICLE INFO ABSTRACT

Key Words: Infection in healthcare facilities is an alarming public health problem in most growing countries.
Barriers, Infection Control Nurses, Infection Hospital infections are the most signi cant worldwide complication of healthcare delivery.
Prevention, Practices Objectives: To acquire a deeper understanding of infection control nurses' perspectives on the
barriers regarding the infection control practices at the tertiary care hospitals Lahore.
How to Cite:
Methods: A qualitative exploratory research approach was utilized. Data was collected from the
Shoukat, S. ., Ali, A. ., & Aziz, Z. . (2023). Perceptions of
infection control nurses. Semi-structured interviews were used to collect the data from the 10
Infection Control Among Nurses Regarding Barriers:
study participants through purposive sampling technique. Each interview was transcribed. The
A Qualitative Study: Perceptions of Infection Control
data were manually analyzed before being processed by NVIVO. Results: A thematic analysis
Among Nurses. Pakistan Journal of Health Sciences,
was conducted to determine the themes and sub themes through Braun and Clark's (2006)
4(01). https://doi.org/10.54393/pjhs.v4i01.487
concept of thematic analysis. The researcher identi ed three major themes and few minor. The
*Corresponding Author: major themes were organization related barriers, health care workers related barriers and
Saffora Shoukat patients and family related barriers. Organization lack of facilities was among the top barriers to
Lahore School of Nursing, Faculty of Allied Health & infection prevention and control. Conclusions: Most of the participants had good and enough
Sciences, The University of Lahore, Pakistan information regarding the infection prevention and control programs, but it doesn't mean that
[email protected] these activities and implementations will be practiced in routine manners. Three major themes
with different barriers were identi ed. Themes well explained regarding barriers in
Received Date: 5th January, 2023 implementing infection control practices in both public and private hospitals.
Acceptance Date: 28th January, 2023
Published Date: 31st January, 2023

INTRODUCTION
Nurses play an essential role in promoting patients' health increases [3]. HCWs especially nurses, are at high risk of
and providing medical care and treatment. ICP practice, occupational hazards because they perform their clinical
often known as IPC, is one basic responsibility of ICN at all duties in hospitals [4]. The hospital infection prevalence
health care settings. IPC practices are "scienti c ideas and rate is increased worldwide. It accounts about 12 million in
practical solutions to prevent infection-related harm to the united states in 2021, and the prevalence is high in
patients and health care personnel engaged in the delivery intensive care units as compared to other units [5]. In the
of health care" [1]. To limit HAIs in patients and nurses, it is Asia-Paci c region, it is reported that 25% of patients carry
vital to adhere to the IPC's principles and practices. hospital infection during their stay in the hospital, which
Infection in healthcare facilities is an alarming public health has been estimated to be 20 times higher in growing
problem in most growing countries. Hospital infections are countries compared to developed countries [6]. In South
the most signi cant worldwide complication of healthcare Asia, the HAIs prevalence rate is higher at 15.5 % in meta-
delivery. It complicates patient care and increases hospital analysis studies [7]. In Pakistan, the HAI rate in the
stays [2]. Presently, the overall occurrence of hospital intensive care unit is 25% as compared with the general
infection has been expanded in developing countries by medicine department [8]. According to recent research,
30%–50% and the burden of these infections surprisingly 84,000-204,000 patients get infections from CLABSI and

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 Perceptions of Infection Control Among Nurses
Shoukat S et al.,
DOI: https://doi.org/10.54393/pjhs.v4i01.487

around about 25000 die from this infection. 12–25% is a and improve the study's validity. The trustworthiness of the
death incident rate of CLABSI. Another study shows that data was checked by adopting several re exive practices.
CAUTI account for about 40% which are 70% and 95% in Secondly, to guarantee impartiality and consistency in the
intensive care units [9]. Additionally, of the patients who study ndings, the researcher designed an audit trail
undergo surgery, 13% become infected with SSI [10]. SSI throughout the analysis phase and kept diaries and
are the most common hospital infection [11]. SSI accounts research memos within the software. Finally, to eliminate
for about 20% of all HAIs [12]. This could be related to poor biased opinions or preconceptions, the researcher was
IC practices or nurses may be unable to follow basic conduct regular feedback sessions and meet with
recommended measures due to barriers and challenges specialists who have an unbiased view of the current study,
[13]. These are considered the major barriers to assuring the collection of valid data. After bringing several
implementing infection prevention practices [14]. This codes together, categories were created. Categories were
study aimed to explore the perceptions of ICN on the main labeled and describe the connection with them. Categories
barriers to IC practices that hinder the effective were converted into themes, then into Sub-themes and
implementation of IPC. major themes. The text was analyzed thematically.
Potential bias or personal motivation should be removed by
METHODS
providing a rationale for the decision. Audio-recorded data
The study was conducted in the infection control was transcribed into text les, and then imported to NVIVO
departments of different private and public tertiary Data analysis software was conducted with NVIVO version
Hospitals in Lahore. An exploratory qualitative study was 12, and the contents was analyzing thematically. The
used. The exploratory qualitative design is best t in the elements of trustworthiness criteria were followed to
study because it is exible in nature [15]. This study aimed ensure the rigor of the study. Trustworthiness means the
to explore the perceptions of infection control nurses capability of the investigator to convince the reader
regarding barriers of infection control practices. Purposive regarding the accuracy, applicability, consistency and
sampling was used to select the study participants [16].The neutrality of the study ndings and interpretations.
anticipated sample size ranged from 10 to15. However, the Credibility is the con dence in representation of the data
de nite sample size was 10 as data saturated. The data was [17]. Non-verbal gestures of the participants were noted in
collected between June and August, 2022. Interviews were the eld notes. Moreover, pilot testing of the interview
conducted by the primary researcher in the Urdu language. guide was done on two clinical instructors to ensure the
Faces to face semi structured interviews were conducted. credibility of the interview questions. For the purpose of
The interview questions were developed based on barriers dependability and stability of the data, interviews were
in infection control practices. To enhance the quality of transcribed in Urdu then translated in the English language
interviews, rigor was applied in terms of trustworthiness, for a thorough understanding of readers. Additionally,
credibility, and transferability. Conformability was checked transcripts were validated by repeatedly listening to the
by r e p e a t i n g t h e a n swe r b a c k to p a r t i c i p a n t s . recorded interviews. Conformability refers to ensuring the
Con dentiality of the data and interviews was assured in objectivity and adequacy of information. Conformability
well manners. During the in-depth interviews, the following was assured by writing re ections to avoid self-biases.
questions were asked: Transferability refers to whether the ndings of the study
1. What is infection and infection control practices? would be applicable to other settings [17].
Please explain.
2. What is your point of view regarding the RESULTS
importance of infection prevention and control? A total 10 infection control nurses participated in this
3. Tell me about the practices at your hospital? research. They were all skillful in their eld of infection
4. What are the main barriers of infection prevention prevention and control program. The demographic
and control program at your hospital? characteristics were shown in table 1.
5. Your point of view regarding changes that need Gender N(%)
to improve infection control program Male 03 (30%)
In addition to the interviews, demographic data including Female 07 (70%)
age, gender, quali cation, years of experience and Age
placement of job were collected by a self-administered 28-34 03 (30%)
35-40 07 (70%)
questionnaire. The investigator was consensus-based
Quali cations
conversation with enough informant feedback, which acts
Post RN 03 (30%)
as a member check to provide more insights into the data
Generic BS 04 (40%)
NMSN 03 (30%)

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 Perceptions of Infection Control Among Nurses
Shoukat S et al.,
DOI: https://doi.org/10.54393/pjhs.v4i01.487

NMSN 03 (30%) The participants identi ed various organizational factors

Teaching Experience as barriers to the IC practices. Some highlighted barriers
2-6 years 07 (70%) are discussed below. The most of the ICN explain the
7-11 years 02 (20%) shortage of resources in the departments as the leading
≥ 11 years 01 (10%) barriers to IC practices. Some major facilities shortage
Clinical Experience
addressed by the participants, such as lack of resources by
2-6 years 07 (70%)
the organization. Sometime participants faced the
7-11 years 02 (20%)
problems of un availability of PPEs. Some time they have all
≥11 years 01 (10%)
facilities but there was no manpower to use these facilities.
Table 1: Characteristics of the Participants
An important issue was present, and an ICN observed it. "I
The participant's narratives were analyzed and placed into have never observed a single patient wash their body in the
three main themes which were related to the research ward for the past few days, though there is a pipeline
questions of the study. Mainly these categories were installed", but there was no hot water for winter season” (IC
organizational, and HCW, patient/ family members' visitor N-02). As illustrated by one of the ICN, " if we have good and
barriers. Each theme has some sub themes as discussed advance facilities it will enhance our infection control
below ( gure 1 and gure 2). Description of the sub themes practices but if equipment is not good and advance then it
is provided in proceeding sections along with the relevant is a barrier in maintaining standards of " (ICN-04). In
interview of the participants. interviews most of the participants addressed the budget
problems. Sometime very short budget kept for ICP or
Infection sometime this area ignored. An ICN stated that “Budget
control should be xed so that we may know the availability of
measures
things in the budget. Budget is not xed in any hospital.”
Signi cance of (ICN-01). Another participant said;“If our material and
Suggestions &
recommendations
infection control resources are short, budget is short, and then we are
practices
unable to control spread of infections. Reasonable budget
for infection prevention material should be maintained”
Major Themes (ICN-06). Over all the participants mentioned in their
interviews that regular monitoring should be done on
regular basis for the maintenance of equipment and
Barriers and obstacles Carry out infection materials. In CSSD all equipment and apparatus must go
in implementation control practices
through under proper observation and standardized
procedures. Maintenance problems were re ected by most
Major Facilitators
participants. One of the study participants stated that; “If
we talk about administration, if it is good so it can be
positive sign for the nurses as well as patients.
Figure 1: Major Themes of barriers Unfortunately, the management and administration is not
Intervention control
fully involved in the maintenance of infection preventive
programs equipment and measures so it may be proved as a main
Infection control SOPs as preventive
measures measures barrier.” (ICN-7). Majority claimed that PPEs are available
Training programs but not implemented strictly and it also becomes a barrier
Signi cance of Importance to IC practices. As stated by one of the participant that;
infection control
practices Perspective “Poor maintenance of infection control measure can be
Excerise practices cause of transmission of infection. Some healthcare
Sub Themes Carry out infection
in hospital
providers have no knowledge and awareness about hand
control practices Self hospital experiences

Role of administration
hygiene and they don't wear PPEs” (ICN-9). Participant
Problems in mentioned that turn over of nurses create many problems
practicing
Barriers and obstacles
in all dimentions of work specially in IC practices. Skillful
Non-implemented
in implementation policies and experienced nurses leave their job due to lack of good
Lack of manpower
oppurtumities . “We have a huge turnover of nurses in our
Suggestions &
Future implications
hospital. We lose around one-third of our intensive care
recommendations Upgrade development staff every six months to the west or the Middle East
Figure 2: Sub themes of barriers countries.” (ICN-9). Participants told that it is di cult to

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 Perceptions of Infection Control Among Nurses
Shoukat S et al.,
DOI: https://doi.org/10.54393/pjhs.v4i01.487

trained new nurses in IC practices and activities because of caregivers' or patients' family faced di culties in
many reasons like time consuming and they need more practicing IPC due to lack of knowledge. Some patients and
nurses to supervise them. Also stated by another ICN that; their guests have negative opinions of the hospital setting.
“As patient in ow is very high but staff is short like ICU One study participant stated that; “Non-compliance on
nurses. New employees are not trained due to shortage of SOPs by family care givers as they are confusing between
time. It is also a big barrier.” (ICN-3). As one of the hand washing and sanitization. Nurses are not giving
participants stated that; “If the HCW providers, especially proper time to it. It is also a barrier or noncompliance or
nurses short in number, then we are unable to provide good showing negligence, least interest.” (ICN-7). One
IC practices. High work load make us to just nish our work participant stated that; “Culture is also a barrier e.g. most
in a way where we cannot follow measures of infection of families strictly avoid alcohol based hand sanitization.
control and prevention”. (ICN-10). The main health care Con ict arises which not resolved, proved as barrier”. (ICN-
workers related barriers are described as under. 4). All participants believe that the presence of too many
Experience: Most of the participants in the discussion families and visitors affects IPC practice and activities
noted that less experienced HCWs did not adhere to proper badly. One participant stated that; “We have a limited staff
standard measures. Participants in certain groups agreed over a huge number of patients.” (ICN-10).
that IPC practices were inadequate due to lack of
DISCUSSION
experience. For instance, one of the participants
articulated, "turnover is very important and basic barriers The study's ndings about barriers and di culties had a
for infection prevention practices. When the experience signi cant impact on IPC procedures. The results can be
staff leave and new staff join and new staff is not trained used to other setups that are comparable in order to
regarding the infection prevention measure it also affect improve IPC actions. To maintain the IPC practices for
infection control in hospitals.” (ICN-05). As one of them HCWs, patients, and families or visitors at the hospital, the
articulated, "A clinical nurse should have clinical provision of toilet, shower, hand-washing material, and
experience and should be able to supervise juniors in other facilities availability is crucial. In this study, the lack
different areas like ICU, CCU, etc. she/he should be expert of resources was seen as a barrier to proper IPC practice.
in handling different equipment and machinery used in This was further substantiated by a related study on nurses
clinical areas" (ICN-07). Most of the participants in the who ignored recommended safety measures [18]. This
session agreed that nurses trained more effectively than conclusion for IP practice was validated by a similar study.
other HCW. One study participant stated that; “negative The study results found many factors as barriers such as
behavior among HCW is also a barrier to the effective IC shortage of staff and lack of facilities. Other signi cant
practices. Sometimes some health care workers don't barriers to the practice of infection prevention were a lack
want to learn, they don't act upon SOPs of ICP.” (ICN-6). A of equipment and supplies, as well as their routine
participant said that “Negative attitude and non- maintenance. Lack of time to practice activities like
compliance on professional care level is a barrier for infection prevention techniques [19]. A similar study found
practicing infection control measures. One person is giving that not having enough time to practice IC in the workplace
good result while the other is not cooperating, it is also a was a barrier [12]. One of the main barriers to IPC practice in
hurdle.” (ICN-4). Another participant stated that “lack of this study was HCW experience. Some of the participants in
Professional communication is a perceived barrier.” (ICN- the discussion agreed that skilled HCWs did not adhere to
8). It is essential for all hospital nurses and other HCWs to proper standard precautionary measures. The importance
comprehend HAI and IPC standards. However, there was a of nurses' skills in addition to technical knowledge was
knowledge gap regarding IPC practices, particularly among emphasized to have an impact on the infection control
cleaners or caregivers. As stated by one participant “Lack practices. According to earlier studies, there may be a
of knowledge is a barrier as well. Nurses provide guidelines, professional gap between nurses and other HCW, when co
lectures, implement on SOPs but audit and monitoring is pared and found that nurses are more adherent with
not done.” (ICN-3). One other participant stated that “if we acceptable standard procedures. The majority of
have limited knowledge and lack of awareness regarding participants in this survey agreed that nurses were
new technologies and new policies is also a barrier for superior to other HCW in some practice of IPC. On the other
prevention of IC.” (ICN-5). In HCW, speci cally nurses, are hand, it was found that attitudes toward IPC (educational
required to provide knowledge to patients regarding background relations), support of organizations and,
transmission based precautions. This information should educational system' priority, availability of time and
be provided to Patients, as well as their family or cares. The capacity of staff were identi ed as the barriers. This
most of the respondents in the discussion mentioned that knowledge barrier was shown to exist particularly in

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 Perceptions of Infection Control Among Nurses
Shoukat S et al.,
DOI: https://doi.org/10.54393/pjhs.v4i01.487

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